dentistry, respiratory hazards, and niosh · chronic progressive lung disease without known cause...
TRANSCRIPT
National Institute for Occupational Safety and Health
Dentistry, Respiratory Hazards, and NIOSH
Randall J. Nett, MD, MPHChief, Field Studies BranchRespiratory Health DivisionNational Occupational Safety and HealthCenters for Disease Control and Prevention
HCSA Sector Council Meeting
August 9, 2019
Dental Personnel About 730,000 dental personnel
in the United States
Bureau of Labor Statistics, 2016
Dentists153,500
Dental assistants332,000
Dental hygienists207,900
Dental laboratory technicians
37,110
Respiratory Hazards in Dentistry Infectious agents Particulates
– Dusts– Fumes– Mists
Gases Vapors Radiation Other hazards
Occupations and Work-Related Lung Diseases Coal worker’s pneumoconiosis or “black lung disease”
Shipbuilders and mesothelioma
Bakers and occupational asthma
Bar tenders and chronic obstructive pulmonary disease (COPD)
Occupations and Work-Related Lung Diseases Coal worker’s pneumoconiosis or “black lung disease”
Shipbuilders and mesothelioma
Bakers and occupational asthma
Bar tenders and chronic obstructive pulmonary disease (COPD)
What about dentists and other dental professionals?
Idiopathic Pulmonary Fibrosis (IPF)
Idiopathic Pulmonary Fibrosis (IPF) Chronic progressive lung disease
without known cause
Difficulty breathing that slowly worsensand dry cough
Likely caused by cycles of epithelialinjury and dysregulated repair
Median survival 2-5 years
Antonella Caminati et al. Eur Respir Rev 2017;26:170047https://radiopaedia.org/cases/normal-chest-ct-lung-window-1?lang=us
IPF Epidemiology Increased incidence and prevalence with increasing age —
presentation most common in 50s-60s
United States– Incidence = 0.22 to 0.88/100,000 – Prevalence = 0.5 to 27.9/100,000
Risk factors– Cigarette smoking– Exposure to stone, metal, wood, and organic dusts– Gastroesophageal reflux disease
NIOSH
Reviewed electronic medical records of all 894 patients with IPF diagnosis at Virginia specialty clinic
during September 1996–June 2017
Identified patients known to be dentists, dental hygienists, dental technicians, or dental assistants
Abstracted medical records
Conducted patient interviews
Performed descriptive analysis
8 dentists and one dental technician
The # of dentists treated was 23-times higher than the # expected
Reviewed electronic medical records of all 899patients with IPF diagnosis at Virginia specialty clinic
during September 1996–September 2017
Identified patients known to be dentists, dental hygienists, dental technicians, or dental assistants
Abstracted medical records
Conducted patient interviews
Performed descriptive analysis
10 dentists and one dental technician
The # of dentists treated was 29-times higher than the # expected
Select Key Findings (n = 11 cases) Males = 11 (100%)
Median age at diagnosis = 65 (range: 49–81) years
Deceased = 7 (64%)
Cigarette smoking = 5 (46%)
Interviewed = 2
– Polishing dental appliances, preparing amalgams and impressions, assisting or demonstrating denture placement using adhesives, developing x-rays, and using disinfectants/sterilants
– No personal protective equipment during 1960s–1980s
Limitations Single tertiary care facility specializing in IPF
Only two patients completed interviews
Multiple patients reported exposures that occurred outside of work
No biopsy specimens available
Proportionate mortality from ‘other interstitial pulmonary diseases with fibrosis’ by industry and occupation classification for select years, National Occupational Respiratory Mortality System
* International Classification of Diseases, Tenth Revision(ICD-10) code J84.1, ‘other interstitial pulmonary diseases with fibrosis’
Are All Cases of IPF Truly “Idiopathic”?
SEM/EDS
(n=30)
Fiber analysis
n = 6• Asbestos = 5• Talc = 1
Non-fibrous
particulate analysis
n=21
• Aluminum silicates = 7• Metals = 6• Aluminum silicates and metals = 4• Silica = 2
Zhao Z, Abraham JL [2012]. Poster presented at the 2012 United States and Canadian Academy
Dentistry-related exposures
IPF
?
Other Respiratory Conditions Asthma
Pneumoconioses– Asbestosis– Silicosis– Dental technician’s pneumoconiosis
Lung cancer
https://www.safetyandhealthmagazine.com/articles/11804-workers-avoid-talking-to-doctors-about-job-related-asthma-niosh-sayshttps://ctsurgerypatients.org/lung -esophageal-and-other-chest-diseases/lung-cancerhttps://ctsurgerypatients.org/lung -esophageal-and-other-chest-diseases/lung-cancer
20
Reducing Occupational Hazards
Hierarchy of ControlsMost Effective
Least Effective
Physically remove the hazard
Replacethe hazard
Isolate people from the hazard
Change the way people work
Protect the worker with Personal Protective Equipment
https://www.cdc.gov/niosh/topics/hierarchy
Surgical Masks Are Not Respirators! Physical barrier
Protects against droplets
Do not protect against:– Small particles– Gases– Vapors– Fumes
The Right PPE Must Be Worn Correctly!
NIOSH Health Hazard Evaluations Worksite epidemiologic/industrial hygiene investigation in response to a
request from employees, employers, or unions
Determine whether harmful exposures, processes, or conditions exist OR cause injuries or illnesses
Involve employees at every step
No cost to the employer or employees
Public final report
NIOSH Health Hazard Evaluations Can be requested by:
– 3 current employees (can be confidential)
– Union
– Employer
Requests for technical assistance
– Other government agencies
– State and local health departments
How are Health Hazard Evaluations (HHEs) Requested?
By requesting a form by calling513-841-4582
On the NIOSH HHE Websitehttp://www.cdc.gov/niosh/hhe/request.html
Information Gaps Prevalence of morbidity and mortality
Dental assistants and dental hygienists
Current work-related exposures
Associations between inhalational exposures and respiratory health outcomes
Planned future studies Health
– Expanded case-series– Tissue analysis– Mortality study
Exposure– Exposure assessment study
Exposure-health study
For more information, contact CDC1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Questions or comments?
Randall J. Nett, MD, [email protected](304) 285-6255